Abstract
BackgroundGlobal policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. However, the status of integration between these two services in Tanzanian health facilities is unclear. This study examined determinants of facility readiness for integration of family planning with HIV testing and counseling services in Tanzania.MethodsData from the 2014–2015 Tanzania Service Provision Assessment Survey were analyzed. Facilities were considered ready for integration of family planning with HIV testing and counseling services if they scored ≥ 50% on both family planning and HIV testing and counseling service readiness indices as identified by the World Health Organization. All analyses were adjusted for clustering effects, and estimates were weighted to correct for non-responses and disproportionate sampling. Descriptive, bivariate, and multivariate logistic regression analyses were performed.ResultsA total of 1188 health facilities were included in the study. Of all of the health facilities, 915 (77%) reported offering both family planning and HIV testing and counseling services, while only 536 (45%) were considered ready to integrate these two services. Significant determinants of facility readiness for integrating these two services were being government owned [AOR = 3.2; 95%CI, 1.9–5.6], having routine management meetings [AOR = 1.9; 95%CI, 1.1–3.3], availability of guidelines [AOR = 3.8; 95%CI, 2.4–5.8], in-service training of staff [AOR = 2.6; 95%CI, 1.3–5.2], and availability of laboratories for HIV testing [AOR = 17.1; 95%CI, 8.2–35.6].ConclusionThe proportion of facility readiness for the integration of family planning with HIV testing and counseling in Tanzania is unsatisfactory. The Ministry of Health should distribute and ensure constant availability of guidelines, availability of rapid diagnostic tests for HIV testing, and the provision of refresher training to health providers, as these were among the determinants of facility readiness.
Highlights
Global policy reports, national frameworks, and programmatic tools and guidance emphasize the integration of family planning and Human immunodeficiency virus (HIV) testing and counseling services to ensure universal access to reproductive health care and HIV prevention
Adolescents and young adults, especially women aged 15–24 years old, were reported to be at high risk of acquiring new HIV infection [2, 3]. This burden of the HIV pandemic in Sub-Saharan Africa (SSA) is in parallel with the challenges of the unmet needs for family planning (FP), which results in a high fertility rate [4]
The low proportion of FRIFHS observed in this study was in contrast to the findings of a study performed in Uganda to assess the integration of routine rapid HIV screening in urban FP clinics, which indicate that about 78% of staff were ready for integration and rated it as a successful effort to expand routine HIV testing in FP clinics [63]
Summary
National frameworks, and programmatic tools and guidance emphasize the integration of family planning and HIV testing and counseling services to ensure universal access to reproductive health care and HIV prevention. Adolescents and young adults, especially women aged 15–24 years old, were reported to be at high risk of acquiring new HIV infection [2, 3]. This burden of the HIV pandemic in SSA is in parallel with the challenges of the unmet needs for family planning (FP), which results in a high fertility rate [4]. A high unmet need for FP in SSA has been reported among HIV-positive women [7, 8], which has compromised efforts to prevent about 160,000 HIVpositive newborns annually due to unintended pregnancies [9,10,11,12]
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